Anne[a]
ASCO 2005 Abstract No: 1581
Adjuvant temozolomide therapy at continuous low dose after first relapse in patients with glioblastoma multiforme treated initially with radiation plus standard-dose temozolomide: report of two cases
M. Bjeljac, U. Huber, S. Kollias
Background:
Recurrent glioblastoma multiforme (GBM) is resistant to most therapeutic endeavors, with low response rates and survival rarely exceeding six months. Temozolomide is an effective agent in the treatment of recurrent malignant gliomas. The standard dosage is 150-200 mg/m2 per day for 5 days in a 28-day cycle. Actual findings established a continuously administered daily temozolomide dose (75 mg/m2 per day, 2 weeks on, 1 week off) that suggested a superior response rate.
Methods:
We report here two cases of high-grade glioma treated with surgery, radiotherapy and subsequent temozolomide chemotherapy after first surgical intervention. After tumor relapse and second surgery, treatment was followed by continuous low-dose temozolomide over long time-period.
Results:
The first patient is a 29-year-old woman who presented with high-grade glioma localized in the right postcentral gyrus. The tumor was surgically subtotal removed, followed by radiotherapy and subsequent standard temozolomide chemotherapy (4 cycles total). Six months after the first intervention occured relapse of the tumor. Continuous low-dose treatment with temozolomide was initiated after the second tumor resection. Subsequent controls of the patient 23 months after the 1st relapse showed no further relapse. The second patient is a 52-year-old male who had a GBM localised in the left medial temporal gyrus. After nearly total tumor resection the patient was subsequently treated with radiotherapy and standard temozolomide chemotherapy (3 cycles total). Relapse of the tumor occurred seven months after the first surgical intervention. After exstirpation of a relapsing tumor a continuous low-dose temozolomide treatment combined with thalidomide was initiated. Twenty six months after relapse, still no signs of tumor recurrence were noticed.
Conclusions;
In both cases, temozolomide was well tolerated without any signs of hematological toxicity. The two patients presented here treated with extended low-dose schedule of temozolomide appear to have a clear clinical benefit and show a notably prolonged survival time.